The present invention relates to a new method for the treatment of vascular (migraine, cluster) and tension headaches and atypical facial pain.
In accordance with the invention, the method of treatment for these headaches and atypical facial pain consists of the application of bursts of low power laser light to the area of intra-oral tenderness associated with the above conditions. This zone of tenderness is in the area of the plexus formed by the posterior and middle superior alveolar branches of the ipsilateral maxillary nerve. The aforesaid zone of tenderness is located bilaterally when the symptoms are bilateral and unilaterally when the symptoms are one sided.
In the case of tension (muscle contraction) headaches in the frontalis (forehead) and/or orbital region, the laser emitted radiation can also be applied to the supraorbital nerve as it emerges from the supraorbital notch or foramen over the eye. This laser application is performed either separately or in conjunction with the above treatment. The intra-oral tenderness associated with vascular headaches and facial pain disappears immediately after intra-oral laser application, returning in approximately three hours to a few days. With repeated applications, a marked decrease/elimination of the intra-oral tenderness and similar elimination of vascular headache and facial pain frequency and intensity have been observed. Immediate relief is often noted when the patient is symptomatic. In the case of tension headaches, the treatment is usually confined to the symptomatic patient, for immediate relief.
Headaches can be classified into three main groups: vascular (migraine, cluster), muscle contraction (tension), and traction and inflammatory headaches. The latter group may be caused by stroke, hypertension, hemorrhage from an aneurysm, brain tumor, infections, or inflammation.
Migraine is the most common type of headache causing patients to consult a physician. According to the American Council for Headache Education, migraine type headache is reported to occur in 18% of females and 6% of males in the United States. Considering this incidence, the economics of migraine, time lost from work, inefficiency, etc., is substantial. Effective treatment can increase the patient's ability to live a normal and productive life. In addition to pain, the symptoms most commonly associated with migraine include nausea and vomiting, photophobia, phonophobia, pallor, and a desire to lie down. Cluster headaches occur much less frequently than migraines and mostly in men (90%), who usually describe severe unilateral eye pain, associated with ptosis (drooping eyelid), eye tearing, and nasal congestion and/or discharge. These relatively brief but severe headaches occur daily (or more often) during the cluster period, which may last for several months. Atypical facial pain is relatively constant, mostly unilateral, and appears unrelated to jaw function. These patients undergo irreversible dental changes (root canal therapy, multiple extractions) with no appreciable benefit; they respond poorly to all forms of treatment.
Multiple humoral agents have been postulated as being the major factor in migraine. These include serotonin, histamine, prostaglandins, platelet factors, endorphins, and vasoactive neuropeptides. The etiology of migraine has been studied by many investigators. Present research no longer supports the vasodilator/vasoconstrictor mechanism of vascular headache (arterial dilation causes pain and constriction equals relief). Research has now implicated the meninges as the source for vascular head pain, as an unknown trigger activates perivascular trigeminal axons which release vasoactive neuropeptides (substance P, calcitonin gene-related peptide, etc.). These agents produce a local sterile inflammation, causing transmission of impulses to the brain stem and higher centers, for the registration of head pain (Moskowitz MA, Trends in Pharmacological Sciences - August 1992) The intra-oral zone of tenderness located in the area of the root apices of the maxillary molars appears to be the trigger that lowers the threshold for trigeminal axon activation. In the presence of this lowered threshold, various other triggers can cause the headache, for example, hormones, wine, chocolate, changing weather fronts, etc.
Migraine therapy is either prophylactic or symptomatic. Prophylactic medication may be selected for a patient with 2-4 headaches per month, if they are severe enough to interfere with daily activities. Beta blockers such as propranolol (Inderal) are the most common. Other medications, often used, are serotonin antagonists such as methysergide maleate (Sansert), calcium channel blockers (Verapamil), amitriptyline (Elavil), and ergotamine preparations with belladonna alkaloids and phenobarbital. These all have significant side effects such as sedation, loss of energy and drive, dry mouth, constipation, weight gain and gastrointestinal cramping and distress. For symptomatic treatment, ergotamine with caffeine (Cafergot) is commonly used. Other medications include isometheptene mucate (Midrin), NSAID's (Motrin, etc.), dihydroergotamine, and the newer medication sumatriptan (Imitrex) which has to be injected intramuscularly. When narcotics, such as Fiorinal with codeine are frequently used, additional hazards include the considerable potential for rebound headache and habituation.
Cluster headache therapy includes steroids (prednisone), Sansert, various ergot compounds and lithium (for chronic cluster headaches). All of these medications can produce serious side effects and complications. Most neurologists regard atypical facial pain as psychogenic and poorly responsive to all forms of medication. Amitryptaline at bed-time and/or various analgesics and narcotics are commonly used for this condition.
Other modes of treatment for these conditions include: (a) Acupuncture, (b) Biofeedback, and (c) Chiropractic. Acupuncture and chiropractic have been used for headache relief, but studies have failed to show that treatment is much more effective than placebo. Acupuncture requires a highly trained acupuncturist. Biofeedback-training in muscular relaxation may be helpful for muscle contraction headache in selected individuals, but controlled studies have not demonstrated success in the above conditions.
The need for a more appropriate method of treating vascular headaches and atypical facial pain is apparent; the previous methods having often proved ineffective. Treatment with pharmacologic agents is associated with toxicity and must be used systematically. These agents do not meet with patient acceptance or compliance. Migraine headaches represent a tremendous economic loss, considering the number of individuals afflicted, the time lost from work as well as the inability to enjoy a normal pain-free life.